REFORM OF MENTAL HEALTH LEGISLATION AND CARE IN ARMENIA/CEE
In communist countries the situation with advocacy for persons with
mental disabilities totally differs from one in the civil societies. There
was neither a legal system nor a civil tradition to advocate for the rights
of persons with mental disabilities. The mental health care system was
designed in a way, that the corner stones of system – in-patient psychiatric
institutions - regards their mission more to punish than to care or help.
Persons with mental disabilities were seen as a people, who has to be isolated
from the society and their life were under the strong control of so called
“dispensers”. Moreover, in former Soviet Union there was not even legislation
to regulate the field of mental health. The basic human rights of these
people were violating in every step of their lives: it is written a lot
about psychiatric abuse in political reasons in countries of the region,
there is an awareness that there was a serious abuse and violation of rights
of persons with mental disabilities on a social and economical levels.
But there is another very important right, from which persons with mental
disabilities were deprived – the right of being a part of the society,
to participate equally with others in everyday life. In the communist era
a majority of persons with mental disabilities were kept in institutions,
far away from communities, under vigilant control of personnel, with trampled
dignity, were so called “instructions” gave a extraordinary authority to
the personnel.
Similar was the situation in mental health services throughout Eastern
and Central Europe. Although, in some of the countries of that part of
the region there was some legislation, regulating rights of persons with
mental disabilities, the situation with observation of human rights was
practically the same as in USSR and the basis of system was segregation.
Since perestroyka starts, because of publication of facts of political
abuse in psychiatry, in 1988 order of Minister of Health of USSR was issued.
This document for the first time in this part of world regulates the mental
health issues.
Later, with global process of transition in this region, situation
with advocacy for persons with mental disabilities started to change and
now it differs from country to country. Some countries of Eastern and Central
Europe revised their existing legislation, some created new, in some countries
advocates proposed the drafts of the law, in some although there is modern
law situation with observation of elementary human rights becomes worse.
But still, the system of services for persons with mental disabilities
do not satisfy the most important demand of advocacy groups – transition
from segregative care system to community based services. International
and governmental agencies were trying to facilitate the living conditions
of persons with mental disabilities by providing food and shelter to the
needy. But not much had been done to assist them in the process of integration
and adaptation into society. Only in a few countries of the region there
are community-based services for persons with mental disabilities. In others
even small pilot services do not exist. This violates the most important
right of persons with mental disabilities – integration into community
and caused complete isolation of from the communities. Isolation caused
new psychological and social problems. Lack of wide range of community-based
services is the serious problems for persons with mental disabilities.
The research will cover the following areas:
review and comparative analysis of mental health legislation in Eastern
and Central Europe and former USSR
review and comparative analysis of existing system of care for persons
with mental disabilities in Armenia, Hungary, Poland.
summarizing of experience of community based services and activities
of advocacy organizations for persons with mental disabilities in the region
design of new advocacy strategies appropriate for the region.
Researches show that the countries with law GDP and permanent lack of
finances, poverty and high level of criminality, plenty of vulnerable groups
have difficulties with observation of human rights in general, and in mental
health in particular.
Countries in the transition are changing the whole system of mental
health services and establish new services at the same time legislative
reforms. Lack of mental health legislation creates serious risks for persons
with mental disabilities. The basic principles of mental health legislation
are stated in UN Resolution 46/119 adopted on 18 February 1992 and in “Ten
Basic Principles of Mental Health Care Law” of World Health Organization.
Other important standards are stated in UN Resolution “Equal Opportunities
for Persons with Disabilities” and some European Council documents.
The law itself and the implementation of law are different processes.
Even the existing legislation framework does not solve the problems with
advocacy for persons with mental disabilities. More efforts have to be
done to enforce legislation and to implement law into everyday life. Human
rights in mental health is more large than good, democratic legislation,
which fits in any and every international human rights standards. Adoption
of new law is the first and easiest step on the long path of reforming
of services for persons with mental disabilities in the transition. Law
could be only the paper if strong advocacy will not forced its implementation.